Tuesday, 29 November 2011

29th November 2011

This morning a young woman in the ward died. She had been admitted yesterday following a series of eclamptic fits which she started having at least a couple of days previously. She came from a town very near to the Sudanese border, some 150km away. The hospital that her family had taken her to when she became unwell – presumably she had not had any antenatal care – does not have an obstetrician but the doctors there had given her diazepam for her high blood pressure. As you would expect, the blood pressure remained problematic and with the baby still unborn, she started to have a series of fits. It’s not clear exactly what happened after this but she arrived at Gimbie hospital more or less unconscious, was then delivered of a healthy baby girl using forceps and given some magnesium for her blood pressure. Sadly, the mother never regained consciousness and this morning had fixed dilated pupils and a few hours later she died. An entirely preventable death. If you read this Heidi and Heli, you will not be surprised to hear of this outcome. All very sad.

Our fridge has broken down yet again and so today two men came to take it for repair. I’m not convinced that we will see it again for some time so will have to ask Clara if she can keep our much treasured cheese bought from Addis in her fridge for now.

You are never really alone in Ethiopia.....
Word quickly gets out that there is a faranji in town and everyone comes to look at the strange sight.

28th November 2011

We were invited to lunch at one of the health centre nurse’s house today. She had a lovely, albeit very compact house, where she carefully laid out some pasta with tomato sauce for us. The house was just one room and had a curtain to screen off her bed (a mattress on the floor). It was immaculately clean, probably made easier by the paper that was stapled to the mud walls and plastic floor covering. Having just finished our pasta and chai (spicy tea) I was a little concerned to learn that she got her water from the river about 20 minutes walk away. There’s no running water in the village at all, and electricity is sporadically available. Her rent is approximately 10% of the £40 per month that she earns.

 Two nurses who scored the highest in the clinical knowledge assessment were awarded a medical dictionary (donated by Oxford University Press)

Whilst we were seeing the antenatal women, the generator was started as there was a need for the health officer to use the computer – probably to enter the various activity data that has to be reported to the government. Apparently, the generator is only used for this purpose as it is expensive to run and so night-time deliveries are carried out with the help of a candle or a torch.

 This woman was amazed to see her baby on the ultrasound screen

The woman with these twins (heads) was not so pleased. Twins do not do well here. The heads are not joined by the way and there were two placentas so she should deliver easily enough.....

Most women really appreciate seeing that the Honnee (heart) beat is Gari (good)

We hosted a dinner party for 10 people this evening to say goodbye to Heidi, Andrea and Heli. They leave for Addis tomorrow morning to catch their plane back to Denmark. We shall really miss them as we have had some great and amusing times together and have enjoyed their company very much. It’s lovely to have people here to share the troubles, traumas and funny things. Each day brings a new event to amuse or rant over.

Note the luxury items for our dinner party - chocolate and wine!

27th November 2011

Jaba is now 1.7kg and he actually looks like he is putting on weight – his face has changed shape and he even has some padding in his cheeks. He is absorbing his milk really well and even taking some of it via the bottle. He gets a little tired so has to be topped up through the nasogastric tube but things are certainly progressing in the right direction. The other lovely thing is that the nurses are all caring for him really well. Hopefully they can now see that it is possible for small premature babies to survive if you look after them.
This afternoon we washed the car. As ever, we had a crowd of people join us for this event, including 5 very helpful orphan boys who live in the town. They all live together in a house – well, a room actually that constitutes a house – and a young woman ‘cares’ for them. The woman is the same one that tried to give her own 2-year old child away a few days ago and so I’m not sure exactly what care she provides for the boys. They are aged from 8-12 and are incredibly polite and hopeful of any attention. Camilla often takes them out for lunch, where they devour an enormous bowl of spaghetti bolognese each. This is probably the only meal of the day that they get and it will certainly be better than the bread roll that they generally get most days. Having washed the car, they all took their t-shirts off and used the fairy liquid to wash their hair and faces. Their eyes were rather bloodshot afterwards but they didn’t seem to mind. They enjoyed having the chance to wash and clean up – indeed, they asked Camilla if she would buy them some washing powder so that they could wash their clothes. They only have two sets of clothes each and these are desperately in need of repair. The large split in the pants of the youngest boy led to him being teased by other boys when his entire bottom was exposed as bent over to wash his hair. Many people don’t have/wear underwear.

Having completed our car washing, we decided to get a group of people together to play Boules. It started off as an orderly game between a few faranjis and Gadisa, the electrician but quickly deteriorated into total chaos as the children sitting at the side watching couldn’t resist the invitation to play a game. It was lovely to see the faces of the 5 orphan children light up as they found they were pretty good at the game and were certainly beating the faranjis. It brought an hour of fun and excitement in what can be quite a tough life for those boys.

Watching and playing Boules

25th November 2011

Although we have sorted out the insurance for the car, we have hit a total no go area in trying to get permission to keep the car in Ethiopia. The problem is this; If you want to import a car to Ethiopia, you have to pay around 250% tax – the figure changes from time to time and depending on who you speak to, but it’s many thousands of pounds. So consequently, most people do not have a car and those who do, often have a very battered car that could not be described as anywhere near roadworthy. So cars are a highly treasured commodity. Although we only want to temporary import our car, there is always some concern that we will not take the car out at the end of our stay but will instead, sell it at a vast profit. Hence before we came out here we had to buy an international carnet, which is in effect and insurance policy that covers us in the event that the car is not taken out of the country. I think the idea is that the insurance would pay the Ethiopian government the tax if we were to remain here with the car. However, the catch is that you have to be a tourist in order to use the carnet. As you will gather from previous blogs, we are no longer considered to be tourists but rather, residents. So when our visas run out in December, the car has to leave Ethiopia. The only way around this is to have the car here as a volunteer – which of course, we are. There is a very large catch here though; in order to get permission from the government to have the car here as a volunteer, you have to sign over the car to either the charities agency or the ministry of health (both government organisations). Hence you often see government officials driving around in large, presumably donated, 4x4 cars. So we have hit this brick wall in officialdom and haven’t the foggiest idea how to move beyond it.
On a positive note, the car seems to be running OK now so hopefully, the little problem of the engine light has resolved itself.

Thursday, 24 November 2011

23rd November

Sophie flies back to the UK tomorrow, so I left baby Jaba and the two chickens in the capable hands of Andrea and Heidi and we headed off for Addis at 6.30 in the morning. We will stay there for a few nights as this will allow us to sort out yet more paperwork for the car and also pick up Jeremy’s residency permit (this will require a long and tedious day of queuing in the ministry for immigration and foreign affairs). The 470km drive went pretty well, although we did have a bit of a scary moment when the acceleration seemed to fail, a trail of smoke came from the car and the ‘contact the Toyota professional’ light went on. Since we were many miles away from any kind of garage, let alone a Toyota specialist this advice from the car manual wasn’t particularly helpful. Having pulled to the side of the road, opened the bonnet and contemplated the possible options, we concluded that the oil might be a bit low and that the steep incline that I had just driven up had created the problem. To be honest, there wasn’t a lot that we could do so we tried the engine again and luckily it went OK. Having driven cautiously to the garage some 30 miles away and poured in a litre of oil, we proceeded with our journey uneventfully. We will check the oil again tomorrow.

22nd November

I have been out to the health centre and health posts in Nole over the last couple of days to work more on my risk screening project. I am seeing about 30 women each day and managing to get them seen by the midwife for an antenatal check and then I take some risk assessments and scan them. I have been documenting the information and will need to work out a mechanism for following up the women to see what actually happened during their labour. At the moment, around 20% of the women have risk factors that would suggest that they should deliver their baby in a hospital. They have been advised to do this but it will be very interesting to see whether they actually take this advice, and if they don’t whether they run into trouble if they deliver at home.
It’s quite amusing going right out to the health posts because these places are really quite remote and many people there have never seen a faranj before. So they are fascinated to see 2 or 3 white faces arriving at their village in a car – another rare sight. Indeed, when at Nole health post, we found around 200 children (age 5-16) clinging to the health post fence trying to get a glimpse of us. I guess that in a world where you don’t have any television or radio and due to a lack of electricity, you have to go to bed when it gets dark, a few faranjis make a pleasant change to the usual routine of the day.

The health post is a very small building, often containing two rooms but without running water or electricity. The idea is that these places are nearer to people out in the villages, with most people being able to reach one within a 1-2 hour walk. They provide vaccinations for children and some health advice for various sections of the population, including pregnant women but they are not allowed to dispense drugs and are not staffed by trained clinical staff. On the whole, the health extension workers work out of the health posts – these are people who have had one year of training on 12 different aspects of healthy living. So it tends to be a health education role. So it was rather odd to find piles of out of date drugs stashed in the store cupboard. Most were drugs for TB treatment but there were also iron and folic acid tablets, which would have been of more help to the tired pregnant woman than the bottle of Mirinda that she was advised by the Ethiopian midwife to drink. Mirinda (fake orange Fanta) seems to be something that all women drink once they go into labour. Sick women also seem to be given the same drink, even though they are barely well enough to drink water let alone fizzy orange.

Also in the store cupboard, which by the way was covered in dust and had much evidence of rodents, there was a box of about 30 digital thermometers, all still in their boxes. I really don’t know what they were doing there, other than gathering dust, but it’s crazy as there is just one thermometer for the entire female ward in Gimbie. I assume that the drugs, and the thermometers had been donated by some charitable organisation – indeed, there were also some out of date United Nations rehydration sachets there. I suspect that all across Africa there are examples of donated goods being given to people who are not in a position to use them. I’m sure it is difficult for the donors to ensure that that things get to the right places but when you actually see these things and know that you could really have used them to benefit those in need, it leaves you feeling quite exasperated.

I still have mixed views about the impact of the various aid programmes on Africa. It’s certainly a complex picture, and Ethiopia, having been a recipient for so many years, is paying in some way for the World’s input into their survival. Looking at places like Gimbie, where there has been considerable assistance over the years, you notice a changed culture in the people. The faranjis sit there like beacons signifying potential monetary assistance.  The Ethiopians, with their ‘dog eat dog’ approach to being the recipient of the faranji’s money will appear to befriend the faranj, but within the first of second meeting (there is always more than one meeting) they will have revealed a desperate story about their starving family, each of whom needs assistance with an operation, schooling, food, clothes, medication and so on. What to make of it all?

Oh well, I go back to my risk assessments and I ignore the 12 inch lizard/reptile thing that it hanging on the curtain above my head……

20th November

Since it is Sunday today, we thought we would go for a drive with Clara, Sophie and Camilla. Someone had said that there was a lake nearby and so we planned to have a walk around this. However, just as we were ready to set off, Jeremy opened the car window and there was a horrible cracking sound as the window collapsed at one end. It was impossible to get the window back straight in the door and so we had to remove the inside panel of the door – not an easy task. It turns out that there is a plastic panel that connect the glass to the door mechanism and this had broken. At least it wasn’t the glass that was cracked. Luckily our car repair kit contained some superglue to repair the broken panel. When I opened the glue, however, the heat had put the tube under pressure and the glue shot out like a water fountain, covering the glass, my hands and some of my hair. Despite my mild panic about being permanently fixed to the tube of glue, I managed to stick the broken panel and we put the window and door panel back. So as not to be totally defeated, we went for a little drive to a nearby village, had a drink in the ‘bar’ where everyone thought it hilarious to see our white faces, and then returned back to the campus. Oh well, I’m sure that we will get a trip out soon. In the meantime, I am a bit worried about whether the repair job will last and so we have decided not to open the car window.
 Camilla got back to her house this afternoon to find a woman and a 2-year old child waiting for her. It turns out that the woman doesn’t have a husband and being just 17 years old, she is keen to continue her education as she sees this as the only way to get a job. She hands Camilla a note that informs her that the woman would like her to take care of her child so that she can go back to school. After reading the note, the woman hands the rather stunned child over to Camilla and tries to leave her with her.  Much to the woman’s disappointment, Camilla hands the child back and tells her to leave. There is a sense here in the town that women are always on the lookout for a faranj who might take their child to a ‘better’ place. Yet when you go out to the villages, you are met with a very different reception. Here, the children all seem to look after each other whilst the parents work on the land and maintain the house. Faranjis are uncommon here though and so people haven’t got used to the notion of a ‘better’ life in the West. There seems to be some acceptance of their lot. For example; for a lifetime, women carry loads of wood on their back that I can barely lift off of the ground. This leaves them totally crippled and bent double by the time they reach the age of 40. But still they continue to do this. And their children will take over this role when they are old enough – about age 7 or 8.

Saturday, 19 November 2011

19th November

Sorry for the absence everyone but the internet has been down for days and is rather temperomental at the moment. I've been keep the blog up to date on my computer and have posted it for each day below so read these first if you want to follow events as they arose.
 This morning I found Buttercup dead in the corner of the cage - very sad. not sure what happened but she seemed to have tried to escape and her head was burried in the dirt in a corner. I think we will now have to dig a hole and bury her.

18th November

Today is my birthday and I have to say it has been interesting to experience this Ethiopi-western style. Actually, people here don’t really celebrate their birthday as they generally don’t know what date they were born on. They may know the month and perhaps the year, but nothing more specific than that. Mind you, the village women often say they are 20 years old as they hide their greying hair underneath their head scarf. I think they just don’t keep track of the years as they pass by.
As a special birthday treat, the much waited for parcels picked up form the post office were opened - a lovely selection of goodies, which will be rationed over the upcoming weeks. I'm looking forward to afternoon tea on Sunday with cake and I think Friday's supper will be spaghetti bolognese, using the ppuch of bolognese sauce that the Lowtons sent over. Oh such a varied diet coming up.....

Makabe, the cook baked a cake with bananas and raisins (brought over courtesy of Waitrose) in and iced it – not sure how she made the icing as I was out in the health centre all day. We had a little birthday tea with cake and orange squash (also courtesy of Waitrose) and some of the Ethiopians, Danes and Brits came along and sang happy birthday. Heidi and Andrea bought me a chicken for my birthday and Clara bought me some Spanish sausage. The chicken has been named Buttercup and has been put in the cage with the other two. I'm a bit worried that they will be mean to her - three's a crowd and all that stuff.
Then we headed off to the green bar for a beer but had to come back after a while as the kitchen there was closed. So birthday supper was pasta with tomato sauce and a real treat was a sprinkling of Parmesan cheese courtesy of a Danish shop (Heli is visiting from Denmark and brought supplies).
Oh and then we cracked open one of the bars of Green & Black chocolate that the wonderful team from the Postgraduate Medical School sent over - thanks ladies; really appreciated - and everyone savoured a square of chocolate. Amazingly, it hadn't melted at all. Even more amazingly, the customs people hadn't eaten any of it. 

17th November

Excitement of all excitement; when I got back form the health post at Homa today, I found that I had many parcels waiting at the post office. Jeremy has kept them aside for now as it is my birthday tomorrow and so I am going to open things then. What a treat to look forward to.

Homa health post was very interesting – it is basically a village hut situated in the village, where women are encouraged to come for antenatal care. Similarly to yesterday, once the word got around that there was scanning going on, around 30 women queued up in anticipation of seeing the baby’s heart beat of the very neat little machine that I carry around with me all the time. One woman had a very calcified placenta and luckily I remember learning about this when Brenda at St Peters was teaching me to scan. The baby was also rather small and no fluid around it. So we referred her to the hospital, giving her a note to take to ‘Dr Jeremy’.  Since she didn’t have the £3.00 for the return bus fare, we also gave her this to make sure that she did actually attend the hospital.

When scanning in the health post, there's always a huddle of children peering in through the window - I think it's the best show in town. The notions of privacy and confidentiality haven't quite reached here yet.
Then we went to the health centre to find one woman had just delivered a healthy boy and another woman delivered her baby just 10 minutes later. All well and healthy. This is great news because up until last month, women were not coming to the health centres for their deliveries. Now they have around 30 a month.

I came out of the health centre to find Sophie doing, ‘heads, shoulders, knees and toes’ with a group of at least 30 children. They were singing along and doing all the movements and generally having a great time. I think she could have a job here in the school!

Having been to the community health facilities over the past couple of days, I have to say that things are really improving out here. Women are starting to attend the health facilities for antenatal appointments and are even coming in to deliver their babies. This should have a dramatic impact on the maternal mortality rate…..if only we had the data to measure this accurately.
There's always time for a buna (coffee) when out for a day in the villages.........

16th November

When I arrived at Ganji health centre today, there was a queue of 20 women waiting to have an ultrasound scan. Word had got out that this was on offer and so women were flocking to the health centre. This is excellent as this provided an ideal opportunity to offer antenatal care at the same time. It was lovely to see, their largely expressionless faces, beam when I showed them the beating heart of their baby – the scanner provides an excellent quality image and you can see the four chambers of the heart beating really clearly. So I have now learnt to say head, heart, stomach and legs in Oromo. Oh and also ‘it is cold’ which I tell them before squirting the ultrasound gel onto their abdomen. They simply look down and hide a small chuckle when they hear what must be a strange accent.
When I scanned one woman it became apparent that she had ruptured her membranes about a week ago and so I decided to get her to go to the hospital. Since she didn’t have any mechanism to get there, we took her with us, making us a car of eleven people. Yes, very cramped indeed. Unfortunately, the bumpiness of the 2 hour drive pushed her into labour making everything just that little bit more uncomfortable. She didn’t complain though. On arrival to hospital, the baby was induced and all was well for both mother and baby. So a real success story there.

15th November 2011

Despite being in the car for around 16 hours yesterday, we decided to head off for Gimbie today, thinking it would only take us 9-10 hours. All was going really well (well after going hopelessly wrong getting out of Addis) and we stopped for breakfast along the way. Then we came across a diversion which seemed to go on for ever. Only afterwards did we realise that we took the wrong road out of the diversion and ended up going up into the mountains and back down again – around 4 hours in total. Mind you, you would never know which road to take as there were absolutely no road signs and many people that we asked told us different routes. Actually, I think they often don’t know the way and so just make it up.

So we arrived at Gimbie in the dark at around 7pm and popped in to see baby Jaba, who is now 1.45kg in weight and looking rather lively. We dressed him in his new clothes and nappies – thank you to everyone who sent these things out with Sophie – and gave him a feed, which he didn’t vomit. So he seems to have turned a corner and should continue to grow well. He is still at risk of infection but we are hoping that he manages to keep strong.

Sunday, 13 November 2011

13th November

Amazingly, having completed yet more paperwork and bought local and international car insurance, we have now been reunited with the car. So we are heading off to Ethiopia tomorrow morning at the crack of dawn in the vain hope that they will let us cross the border. If we fail, I guess we will be driving all the way back here to rethink things. So another day by the pool - there's not much else to do - and we are trying not to think about what officialdom lies ahead.
If we get through everything, we shall be back in Gimbie by Tuesday evening.

Friday, 11 November 2011

11th November

Well Djibouti is very different from Ethiopia. Apart from it being very, very hot, it’s culturally very different, with a French influence (the language is French, making communication for us reasonable). It’s quite a small country, with a population of just 800 000. I think that most people live around the capital, which is Djibouti city, and much of the rest of the country is desert. The border to Ethiopia is about 150km away.
 We met up with the agent that is supposed to be sorting out the car for us and she was really quite surprised to see us. I don’t know what she expected us to do, however, given that we have not been able to speak to anyone whilst in Addis. It turns out that Thursday afternoon is a half day for everyone, followed by a day off on Friday. So the shipping company were closed by the time we got here and they don’t open until Saturday. So today, once we picked Sophie up from the airport, we decided to spend the day by the pool at the hotel. All is not too bad once you accept that there is nothing you can do to change things. We are meeting the shipping agent tomorrow morning and so will see what additional complications arise…….

 If we get the car, the plan is to set off on our journey to Ethiopia on Sunday. There was some talk about needing 24 hours to sort ‘paperwork’ so I have a feeling that we may end up staying until Monday. Anyway, we are in a nice hotel and enjoying the break from the harsher life in Ethiopia. Djibouti is quite prosperous, having benefitted from the shipping industry they have built up.

Thursday, 10 November 2011

10th November

We are currently waiting at the airport for a 2-hour delayed flight to Djibouti. I wonder whether it was simply cancelled as there weren’t enough people to make it worthwhile. The saga of the car continues, with us finally reaching a point where the agent in Djibouti puts the phone down when she hears our voice. The real problem is that there is no consistency in what we are being told, with about 5 different people telling us different things. Some say that the International Carnet only works for 2-3 days in Ethiopia, others say this is exactly the document you need. Some have said that we need a letter from the British Embassy, but they never seem to be open and when they are, they promise to get back to you but never do. Others have said we have to get a letter from the Charities agency, who, by the way, refuse to give us a letter and then there are those who believe that the ministry of health should provide the necessary letter. So after a couple of days of speaking to anyone who would listen to the woes of the car import, we have decided to fly to Djibouti and see what they say when we get there. We have the International Carnet and that should be enough but who knows?!? It’s about 35C and largely desert so it should be an interesting trip.

8th November

For the first time in a month, I have felt completely full up. We went to an Italian restaurant this evening and had a most amazing meal of truffle pasta and roast lamb. Oh and then forced down some ice cream and chocolate sauce. Yes, we are still in Ethiopia. The restaurant is known for being the best place in Addis and I think that is probably the case. I can see a trip to Addis on a regular basis is going to be entirely necessary. Mind you, my stomach seems to have shrunk and I struggle to eat my way through large portions now.

Tuesday, 8 November 2011

7th November

This morning we went to sort out yet more paperwork to get an Ethiopian driving license. We got as far as having the UK license, which we already got stamped by the British Embassy on our last visit, authenticated at the Ministry of foreign affairs and then head off to the ministry for transport, which is a considerable drive out of town. When we got there, however, the gong for lunch sounded and everyone packed up for the next 2 hours. Since we had an appointment at the Hamlin midwifery college at 1.30, we had to leave without a licence. They did, however, very helpfully give us a form to complete. The only problem is it is all written in Amharic!
 The midwifery college was really quite an inspiring place. They offered a really comprehensive 4-year programme for the students and appeared to support them really well during their clinical placements. It’s an expensive course at $4000 per year, but in all honesty, it seems to me that if Ethiopia is really going to reduce their maternal and child mortality, they are going to have to train their midwives a lot better than they do. Currently, there is a focus on fast track training of general nurses, which lasts for a year. In theory, this sounds ideal, but the quality of the training is variable and the biggest problem is that they lack clinical exposure and so end up being sent out to work in remote areas with little skills. Hence the woman I wrote about in an earlier blog who was induced at a health centre, despite having a breech presentation and then when she failed to deliver (unsurprisingly) she was sent on the bus to get to hospital.

The Hamlin midwifery college seems to not only provide a comprehensive midwifery course but they also ensure that the midwives are supported in their workplaces once they have completed their training.

6th November

After 12 hours of bumping along the dusty, half made road to Addis, we are finally deposited in our hotel. Eagerly, we head for the Greek Club for supper and tuck into a Greek salad and chicken souflaki. There was a big group from United Nations Aid eating there and there seemed to be many speeches, presumably congratulating various people for the good work achieved…….hmmm, I have yet to make my mind up about what is actually achieved by various aid programmes so will save this account until a later date.
 At the last count, I had 46 bed big bites and they are quite itchy so tonight I am looking forward to a bug free night’s sleep.

5th November

I found another baby in the cot with Jaba this morning. The bit of sticky plaster stuck on his wrap had ‘F22’ written on it, presumably because he belonged to the woman in bed F22.  He had been, and still was, in respiratory distress the previous day after delivery following resuscitation and had been kept in the labour room so that he could be watched. From previous blogs, you might be wondering whether this was the best place for him as from what I have seen so far, this is not a place of great observation – well not for babies anyway. Indeed, today was no exception. Jaba was soaking wet and dirty and as a consequence was really quite cold (his hot water bottles were cold, probably having been left from the night before). Baby F22 however, was baking hot as he had been put on the hazardous warming mat that reaches temperatures hot enough to cook a roast dinner. Once again, I removed the ‘boiling’ mat and asked the nurses to send it for repair or get rid of it as it was dangerous. I set to cleaning both babies up and suggested that baby F22 was reunited with his mother as she was sure to observe him as well, if not better, than anyone in the delivery room. He was still on oxygen but he cold have this at her bedside. So he was taken to F22, only to find that she already had a baby in her arms. Turns out that he was actually F23’s baby but someone had written the wrong number on his head. I wonder how often this happens.

Indeed, as I was thinking about this back in the labour room, there were two babies born in quick succession, each being placed next to each other on the table where they are dried and, if needed, resuscitated. Both were boys – strange how many boys are born here – and both lay there waiting to be reunited with their mothers. They were in fact given to the right mothers (I kept a close eye on them) but it was very easy for a mix up to occur.

Saturday, 5 November 2011

4th November

Having re-inserted Jaba’s nasogastric tube this evening – he is so lively that he pulls it out every now and again – I turned round to see that the nurses had placed a recently delivered stilborn baby, wrapped in a plastic bag, in the weighing scales. Here the baby stayed for the next 30 minutes or so that I was in the room. However, the mother of the baby was also in the room, lying on the delivery couch, still covered in blood. So both she and I were left staring at her plastic wrapped baby wondering exactly why the nurse not only felt the need to weigh the baby, but also thought it would be OK to leave him there on full view. This attitude towards life and death is something that is really quite difficult to comprehend but something witnessed almost every day. Early on in the day, a woman’s baby died shortly after birth and when the woman started to cry, having been shown her baby, she was told by the nurse to stop crying as she would soon have another baby and that one would be just fine. Such confidence is hard to acknowledge when all around there is evidence to the contrary. Full term babies should, largely speaking, not die but yet they do. So why would you be so certain that the next one is going to be fine?
Having inserted the NG tube and noticed that baby Jaba had not been fed for the past 5 hours – it’s little wonder he doesn’t gain weight – I asked one of the midwife students to feed him whilst I got his bed ready (tried, unsuccessfully, to find a clean blanket). As usual, the hot water bottles that keep him warm were cold and so I went to boil the kettle in the store room, only to see something jump from the stove and run under the bed. I put the kettle on to boil and went back to find my torch (you always need a torch to walk around at night as the lighting is quite poor and you never know what animal/insect might be lurking). Sure enough, there was a 5-inch rat scuttling around in the room. I told the nurses and quickly left the ward……

This evening we ate some Jack fruit – a most ugly looking fruit with a melon like taste and a sticky texture that makes me wonder whether it is the key constituent of blue tack. Even after washing my hands, the stickiness remained. I was going to give the vast quantity of remains to the chickens but think that it may stick their beaks together.

Thursday, 3 November 2011

3rd November

Well it was total chaos in the labour ward to day. I’ve never seen so many babies born I such a short period of time. You have to appreciate that there are only 2 delivery beds and then there are another 2 ‘waiting to deliver’ beds. Today, however, they were all full and the store room that has a four beds without any covers on mattresses was also full of women in various stages of labour. As soon as one baby was out, the woman had to walk to the ward, swiftly followed by her new born baby. One woman arrived with her baby’s head already dropping out – sadly this was an intrauterine death – another arrived with a cord prolapse and twins (one of whom was rather sickly for a few hours), and another baby aspirated meconium and needed resuscitating. Oh and then a couple of hours later, another baby popped out looking very flat indeed and needed resuscitation. So what with the abandoned baby, Jaba and the other recovering babies, it was beginning to look a bit like a paediatric ward. 

We have now had a couple of Oromo lessons and I think I am getting the hang of it. I can’t wait to be able to speak to people in the market and tell them that I would like to have the Ethiopian price rather than the Faranj price. They will be shocked to hear a faranj speaking Oromo. You can’t blame them for wanting to make a bit of money out of us but it’s the principle that matters. Sometimes, new people here get charged double to going rate – some british people we met here paid 25 birr (£1.00) for a bottle of beer when the standard price is 9 birr (36p).

We are having lentils for supper this evening, which would be nice if we hadn’t also had them for lunch. Mind you, I have just found a packet of Indian spices for daal that I brought with me and this really improved the taste….ie there was a taste! It is papaya season and I’m told that mangos should arrive on the trees fairly soon – very excited about that.

I woke up this morning to find I had a series of about 10 bites on my leg – not sure if it’s bed bugs or whether something got into my clothes and nibbled away. It’s not mosquitoes so not particularly worried (we sleep under a net) but would rather avoid further nocturnal munching……As they say, however, ‘you’re never really alone in Ethiopia’

2nd November

The female ward is beginning to look like an orphanage. A beautiful baby boy was left at the hospital gate last night and was found by the hospital guard, crying, cold and soaking wet. So at 2am, he was warmed and given some of baby Jaba’s baby milk. Luckily, I had been given 2 baby bottles by someone who visited last week and so I now have one for baby Jaba and the other for the new and, as yet, anonymous baby. He looks like he is about 3 weeks old and is quite a bonny little chap.

I’m a little concerned about the supplies of baby milk as a considerable amount of the tin seems to have disappeared over the past week. I am guessing that some of it may be being used in coffee. So from the remains of the tin, I made the new baby some milk, which he drank with gusto and obligingly burped without vomiting any of it up. I’ve also been given 2 t-shirts, which are far too large for Jaba but fit the new baby really well.

So they’re now both settled down for a while and I have time to write my blog. Trouble is, the internet is off again and so I’ll have to post it at a later stage.

It’s a bit odd to have a second abandoned baby, although I am told that there are usually about 3 a year. I did wonder whether word had got around that they would be cared for and might be destined for a better life in the UK or Denmark. Certainly, news travels far here and I am sure that the accuracy of the story becomes more and more dubious the further the story travels.

Wednesday, 2 November 2011

1st November

This morning I was called to the hospital to help resuscitate a 2-day baby who initially had very shallow breathing and then arrested. He had been born by emergency caesarean but had aspirated meconium and hadn’t really picked up since delivery day. In the UK we would have ventilated him but that’s not an option here and so we hand bagged him with an airway in his mouth for about 25 minutes. Unfortunately he didn’t survive. In an attempt to allow the mother some time with her baby, we set up a screened area in what could be described as a general store come spare room when full to capacity. It wasn’t much but it felt important to let her say goodbye in privacy. The trouble is, the resuscitation area is also the delivery room and there were two women in labour whilst we were working on the baby. I can’t imagine what they felt as they watched all the commotion just half a metre away from the bottom of the delivery bed.
 After a few minutes, the baby was brought back into the delivery room, where two nurse assistants wrapped him in a cloth and then gently placed him in a cardboard box, which was placed next to baby Jaba’s cot. He, of course was oblivious to it all but as I was feeding him, I couldn’t help noticing that the box had ‘handle with care’ stamped on the outside.

 There is a ‘prolapse team’ from the states (Oregon) here at the moment and they are providing free prolapse surgery for women who need their uterus pulling up. So you might imagine the place is heaving with women looking for their free operation. Apparently, they also give them a free dress and pair of shoes when they leave the hospital. I'm not sure what this has to do with having a prolapse repair but can imagine that before long, everyone is going to want to have surgery. At the last count, there were 40 women booked in for surgery but looking at the queues in the corridor, I imagine this must have doubled by now. So both operating theatres are working at full steam at the moment, with any emergencies being squeezed in between.

 We are hoping to have our first Oromo lesson this evening. Having found that our original teacher hurt her foot and the second one couldn’t be found, we managed to find someone who sometimes does translation at the hospital. I’ve been picking up the odd phrase like; please can I have one spoon of sugar? (Mallo Zucara manka tokko). This is incredibly handy as they automatically put 3 spoons of sugar in the 75ml cup of coffee. Normally, I wouldn’t take sugar, but when I’m out at the villages I never know when I’m going to get the chance for some calories again. Talking of sugar, it seems that the reason many children have poor teeth is because they are constantly chewing on a stick of sugar cane, which is grown all around this area.